Summary: Ms X complains on behalf of her father, Mr Y, the care provider is overcharging for the time spent with Mr Y and is failing to complete all of the agreed tasks. Ms X says this has amounted to large financial losses. We have found fault in the care provider for failing to confirm how it would calculate its charges. We recommend the care provider reissue its invoices in line with the hours Ms X has recorded it is at Mr Y’s and issue an apology.

The complaint

1. Ms X complains on behalf of her father, Mr Y, the care provider is overcharging for the time spent with Mr Y and is failing to complete all of the agreed tasks.
2. Ms X says this has amounted to large financial losses.

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The Ombudsman’s role and powers

3. We investigate complaints about adult social care providers and decide whether their actions have caused an injustice, or could have caused injustice, to the person making the complaint. I have used the term fault to describe such actions. (Local Government Act 1974, sections 34B and 34C)
4. If an adult social care provider’s actions have caused an injustice, we may suggest a remedy. (Local Government Act 1974, section 34H(4))
5. If we are satisfied with an organisation’s actions or proposed actions, we can complete our investigation and issue a decision statement. (Local Government Act 1974, section 30(1B) and 34H(i), as amended)
6. Under the information sharing agreement between the Local Government and Social Care Ombudsman and the Care Quality Commission (CQC), we will share this decision with CQC.

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How I considered this complaint

7. I have discussed the complaint with Ms X and have considered the documentation she provided.
8. I have also considered the information provided by the care provider sent us.
9. Both Ms X and the care provider were invited to provide comments on my draft decision. Any comments provided have been considered before a final decision was issued.

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What I found

10. Part 3 and Part 3A of the Local Government Act 1974 give us our powers to investigate adult social care complaints. Part 3 is for complaints where local councils provide services themselves. It also applies where a council arranges or commissions care services from a provider, even if the council charges the person receiving the care. In these cases, we treat the provider’s actions as if they were council actions. Part 3A is for complaints about care bought directly from a care provider by the person who needs it or their representative, and includes care funded privately or with direct payments using a personal budget. (Part 3 and Part 3A Local Government Act 1974; section 25(6) & (7) of the Act).
11. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out the fundamental standards that registered care providers must achieve. The Care Quality Commission (CQC) has guidance on how to meet the fundamental standards.
12. The Care Quality Commission (CQC) is the statutory regulator of care services. It keeps a register of care providers that meet the fundamental standards of care, inspects care services, and reports its findings. It can also enforce against breaches of fundamental care standards and prosecute offences.
13. The Care Quality Commission (Registration) Regulations 2009: Regulation 19 says providers must give timely and accurate information about the cost of their care and treatment to people who use services. It goes on to say to meet this regulation, providers must make written information available about any fees, contracts and terms and conditions.

What happened

14. Mr Y came out of hospital in around January 2023 and the hospital organised a care package.
15. The care provider says it began providing Mr Y’s care in July 2023. The care provider says it discussed the times and start time of the package with Mr Y’s other daughter but no longer have a record of the exchange.
16. Mr Y’s care plan says various tasks should be completed in the care providers morning, lunchtime, teatime and bedtime visits.
17. The undated contract signed by Mr Y says the care provider will charge whatever charges it set at the time of the assignment. The contract also says it is in a service users’ interest to ensure staff sign timesheets for each assignment.
18. Ms X complained to the care provider in December 2023 after she receive an invoice from it. Ms X explained that cameras had been installed in Mr Y’s property for his safety and the footage from these showed the care provider was charging for more hours than it provided.
19. The care provider emailed Ms X in early January 2024 answering some questions she had raised. The care provider said it had explained the details of the contract to her sister in January 2023 and a contract was signed by Mr Y on 5 January 2023.
20. The care provider and Ms X met in January 2024 to discuss her complaint. The care providers note about the complaint say it believes it is charging in line with the scheduled hours as per the contract. The note goes on to say the care giver adhere to the tasks assigned and leave when the service user indicates these have been completed.
21. The care provider emailed its private service users in May 2024 to say it was increasing its hourly rate and it would issue a new contract. The new contract says the service user will pay the care provider an hourly fee for the service specified.
22. The care provider has also provided a schedule of attendances for its carers. This does not show a regular set pattern for attendances across a week.
23. I understand Ms X has been paying for the actual hours attended by the carers as shown by the video footage rather than the hours billed by the care provider. This has left a large unpaid balance.

Analysis

24. The care provider told Ms X as part of its response to her complaint that her father signed a contract in January 2023. However, has explained to me as part of my enquiries that Mr Y’s care did not begin until July 2023. The contract referred to is undated so I cannot confirm the date the contract was signed. But, Ms X has provided documentation showing reviews of Mr Y’s care took place early 2023 which would suggest his care began in early 2023.
25. The care provider has explained it does not have a record of what was agreed regarding the times and start time of the package as this would have been discussed verbally. This is fault as a record of this information should have been made/retained.
26. Ms X has queried the charges with the care provider, and it has said it is charging in line with the scheduled hours as per the contract. However, I have not been able to see from any of the documents provided what was agreed either with Mr Y, Ms X or his other daughter in terms of how Mr Y would be charged for his care. This is fault. The care provider should have provided a clear document explaining how charges would be calculated.
27. Ms X has a clear record of the times of attendance by the care provider from the cameras which were installed in Mr Y’s property.
28. In the absence of any documentation showing how it was agreed Mr Y should be charged, the care provider should charge him for the hours spent at his property providing care. Ms X should provide the care provider of the details of the hours spent at the property.

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Agreed action

29. Within one month of a final decision, the care provider should:

• Write to Ms X to apologise for the faults identified.
• Issue adjusted invoices in line with the hours Ms X has recorded for its attendance and refund any overpayment Ms X has made.
• Agree a new contract with Ms X detailing how Mr Y will be charged for his care clearly showing if it will be by the task, hour or for a fixed time.
• Issue any further invoices until the point a new contract is agreed in line with the hours attended as recorded by Ms X.

30. The Care Provider should provide us with evidence it has complied with the above actions.

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Final decision

31. I have found fault in the actions of the care provider for failing to confirm how it would calculate its charges.

Investigator’s final decision on behalf of the Ombudsman

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Investigator's decision on behalf of the Ombudsman